Are You Assisting in Innoculations ?

[tniuqs]

I think he meant it more in the way that EMT-B's do not do drug math, and are not trained in any sort of injection other then auto-injector. If we are giving mass inoculations to the public does anyone really know the pharmacology behind the drug? Or anything about it ? I would be giving it as blindly as an EMT-B with an auto-injector ...

OK cost of one auto injector ??? vs maybe a 3 hour lecture ? (as in Saskatchewan) so when we talk vaccine. Its a one syringe deal, 2 sharps, 2 swabs, drawing either .5 or 1 ml of med, read the label then target and inject ... ALL levels would know enough to document and check for contra indications, make a record and viola ... NEXT patient please.

Inoculation is not an immediate life threatening issue in the first case.

cheers

[tskstorm]

You should always know what you are giving to any patient and a good understanding of how it works.

But in a case like this, do you really need THAT many people giving inoculations?

Well since I can't get a straight answer out of anyone else, and you seem to think you should know what your giving ... can you tell me everything in the H1N1 forumlary ?

I said it in another thread will say it again ... we're an over worked system with 3500 calls a day .. if we had to give out inoculations, we would need everyone to help, couldn't tax all our ALS providers with this task ... No one would be left to take care of patients needing acute ALS care...

[Richard B the EMT]

<BR>

How can you say this? Is it based on standards and scope of practice? If that were the case you could put anything into an "Epi-pen" style autoinjector, where would you draw the line. The autoinjectors used in WMD (generally nerve agents only - Atropine and 2PAM) are 1 1/2 inches long and are 18 gague needles, not remotely similar to an epi-pen (1/2-3/4" and 22-24 gague). I think these are nothing but blue sky statements.

In New York State, EMT-Bs are allowed to "assist a patient in taking" specific meds, like Nitro pills, or epi-pens. Surprisingly, in a career of over 35 years, I have never been called on to do either.

As I stated in a previous post: Well, first the H1N1 vaccine would have to be classified as a WMD. Then they would have to develop a transport medium that would be compatible with autoinjector use (nothing at all kike an epi-pen). The use of autoinjectors at a BLS level (from my understanding) is for self rescue only, not for the general public. Even if for the general public, generally the acceptance would be the benefit of use vs. non use and even then, limited to nerve agents. The better argument would be to have Cipro autoinjectors for anthrax exposure.

I'll chalk up the "vaccine as a WMD" as a typographical error. If exposed to a nerve agent, yes, I'd probably self-inject, for self rescue.

Have you ever seen an autoinjector used on a live model?

I have not. In fact, the only thing we've spent time on, in my refresher classes, is a simulated autoinjector. When you press it, you hear and feel some kind of spring mechanism releasing within the device, and no needle is on the training device. I have been told that in one class, where Paramedic Trainees used an actual autoinjector with a placebo load, in classes at the FDNY EMS Academy, that a lieutenant had his finger in the wrong place, and the needle went through his thumb, complete to the thumbnail. It is my belief and hope that all EMTs, or Paramedics, in the US, Canada, the UK, or anywhere, are praying that a "General Order" to break out the 2PAM, and other "goodies" in the WMD kits, never becomes nessesary.<BR><BR>As for my statement that I'd be working the MIRV, I stated I'd be doing data entry. At no time did i say I was going to be actually doing any injections. If someone thought I WAS saying I'd be doing injections, I apologize for any confusion.

Edited November 1, 2009 by Richard B the EMT

[tniuqs]

'tskstorm' date='31 October 2009 - 10:36 PM' timestamp='1257050188' post='228165']

Well since I can't get a straight answer out of anyone else, and you seem to think you should know what your giving ... can you tell me everything in the H1N1 forumlary ?

Yes and second time posted .... the search engine works.

I said it in another thread will say it again ... we're an over worked system with 3500 calls a day .. if we had to give out inoculations, we would need everyone to help, couldn't tax all our ALS providers with this task ... No one would be left to take care of patients needing acute ALS care...

Isn't that called Dispatch triage it works brilliantly in the UK, when its not a FOR profit system, just think if call volume increased just 2 fold because of panic ... no wait thats already happening.

1.0 Pharmaceutical Form

Arepanrix™ H1N1 (AS03-adjuvanted H1N1 pandemic influenza vaccine) is a two-component vaccine consisting of an H1N1 immunizing antigen (as a suspension), and an AS03 adjuvant (as an oil-in-water emulsion).

The H1N1 antigen is a sterile, colorless to slightly opalescent suspension that may sediment slightly in a 10mL vial. The antigen is prepared from virus grown in the allantoic cavity of embryonated hen's eggs. The virus is inactivated with ultraviolet light treatment followed by formaldehyde treatment, purified by centrifugation and disrupted with sodium deoxycholate.

The AS03 adjuvant system is a sterile, homogenized, whitish emulsion composed of DL-α-tocopherol, squalene and polysorbate 80 in a 3mL vial.

Immediately prior to use, the full contents of the AS03 vial is withdrawn and added to the antigen vial (mix ratio 1:1). The mixed final product for administration is an emulsion, containing enough product for 10 doses.

OMG WHERES MY CALCULATOR AGAIN ?

Top of Page

2.0 Qualitative and Quantitative Composition

After combining and mixing the two components, 0.5mL of the resultant emulsion is withdrawn into a syringe for intramuscular injection. The final composition of each vaccine component per 0.5mL dose is as follows:

Antigen:

Split influenza virus, inactivated, containing antigen* equivalent to:

A/California/7/2009 (H1N1)v-like strain (X-179A) 3.75µg HA** per 0.5mL dose

* isolated from virus propagated in eggs

** HA = haemagglutinin

Preservative content is 5µg Thimerosal USP per 0.5mL dose or 2.5 micrograms organic mercury (Hg) per 0.5mL dose

Adjuvant:

DL-α-tocopherol 11.86 milligrams/0.5mL dose

Squalene 10.69 milligrams/0.5mL dose,

Polysorbate 80 4.86 milligrams/0.5mL dose

The suspension and emulsion vials, once mixed, form a multidose vaccine in a vial. See section Nature and Contents of Container for the number of doses per vial.

For a full list of excipients, see section List of Excipients under 5.0.

http://www.hc-sc.gc.ca/dhp-mps/prodpharma/legislation/interimorders-arretesurgence/prodinfo-vaccin-eng.php#a1

[tniuqs]

Despite initially beginning a campaign to vaccinate medics at their stations, Winnipeg EMS in Manitoba is being forced to discontinue giving the shots. The Winnipeg Free Press (Mary Agnes Welch/October 31) said the city’s health authority decided late last week to repossess vaccine destined for prehospital responders. According to the newspaper, the doses will now be given to individuals vulnerable to contracting Swine Flu. Though around 500 emergency workers from various disciplines have already been innoculated, some 300 have yet to receive the shots. The tact of leaving medics to fend for themselves is puzzling to emergency workers who are daily exposed to H1N1 dangers. Private air medics in the province, for example, are also scrambling to get inoculated. The Winnipeg Free Press (Carol Sanders/October 30) quoted Keewatin Air air medical operations vice-president Penny Triggs as saying her staff are demoralized by several failed attempts to obtain vaccine alongside the public. Keewatin, which flies in and out of northern Manitoba where patients suffering from and vulnerable to H1N1 abound, could be hard pressed to function during an outbreak without immunized staff.

Ah now a change of priority to just receive the vaccine, it will be interesting following this story is my bet, meanwhile in Nunavut the flight teams are flying to every remote community without illness reported.

[rock_shoes]

So far public health in BC hasn't made any attempt to use paramedics for H1N1 inoculations. I guess they would rather spin their wheels with far too few public health nurses available to provide the mass inoculations needed. It doesn't make any sense to use 3500 capable paramedics to provide vaccinations enmass does it? Why use the very crews you would call should someone have an adverse reaction? There's no way paramedics could possibly vaccinate nursing home residents in their homes is there? Paramedics couldn't possibly visit schools for an afternoon to provide vaccinations?

Ah hell most of BC's paramedics haven't been inoculated themselves yet. Providing care in someone’s home doesn't put you at any kind of exposure risk does it?

Just last week I treated a possible H1N1 patient. 39 y/o female, hx. of asthma and fibromyalgia. She had just come home from the hospital 20 minutes before where she had been treated for SOB with Ventolin (Albuterol) and Atrovent. Her initial room air SPO2 was 77%, with wheezes throughout, poor entry to the bases, and course crackles up to the mid lung fields. She had a fever @ 39 deg Celsius, chills, and diaphoresis. I took precautions before getting within 20 feet of the patient wearing an N95, eye protection, and the usual gloves. My partner, an old timer who was convinced this is all a hoax so drug companies can make a killing, did not take any eye or respiratory precautions. Not wanting to contaminate the ambulance, I treated this patient with 5mg Ventolin in 5mL NS by nebulizer on scene. Guess which one of us, myself or my partner, is now isolated at home with a nasty case of the flu. This is the real thing and the only way I know of to stall the spread is mass vaccination. Every deployable resource needs to be put in play and I have yet to see it.

[WolfmanHarris]

Paramedic at my service are now officially helping with Public Health at the community clinics and are now being set-up to run some mobile clinics in the next couple weeks. This is all above and beyond usual coverage and does not impact response in any way/

[tniuqs]

So far public health in BC hasn't made any attempt to use paramedics for H1N1 inoculations. I guess they would rather spin their wheels with far too few public health nurses available to provide the mass inoculations needed. It doesn't make any sense to use 3500 capable paramedics to provide vaccinations enmass does it? Why use the very crews you would call should someone have an adverse reaction? There's no way paramedics could possibly vaccinate nursing home residents in their homes is there? Paramedics couldn't possibly visit schools for an afternoon to provide vaccinations?

Ah hell most of BC's paramedics haven't been inoculated themselves yet. Providing care in someone’s home doesn't put you at any kind of exposure risk does it?

Just last week I treated a possible H1N1 patient. 39 y/o female, hx. of asthma and fibromyalgia. She had just come home from the hospital 20 minutes before where she had been treated for SOB with Ventolin (Albuterol) and Atrovent. Her initial room air SPO2 was 77%, with wheezes throughout, poor entry to the bases, and course crackles up to the mid lung fields. She had a fever @ 39 deg Celsius, chills, and diaphoresis. I took precautions before getting within 20 feet of the patient wearing an N95, eye protection, and the usual gloves. My partner, an old timer who was convinced this is all a hoax so drug companies can make a killing, did not take any eye or respiratory precautions. Not wanting to contaminate the ambulance, I treated this patient with 5mg Ventolin in 5mL NS by nebulizer on scene. Guess which one of us, myself or my partner, is now isolated at home with a nasty case of the flu. This is the real thing and the only way I know of to stall the spread is mass vaccination. Every deployable resource needs to be put in play and I have yet to see it.

Shock and Awe ....... NOT!

First off damn good call rock_shoes your thread on ventolin paid off <insert applause> So did they swab your partner and PM me this would be an excellent case to present to non believers in EMS, or parliament hill too .. sans names of course, my bet the virology labs are at least month behind would be an easy guess.

All the clinics are closed in AB now as way too many non priority people followed the Websites Alberta and Canada Health and Media advice and got in huge line's to find they were told go fish.

So ..A house wife with 2 eligible and priority children was interviewed on CTV news basically said and a rough quote:

We followed our Health Ministers advice cause they scared the shit out of us, then told a change of plan and we waited in lines for hours with high risk people in the rain a waste of time and increased exposure ...

GOVERNMENTS PULL YOUR HEAD OUT OF YOUR ASSES.

Another comment was Tim Horton's could do a better job ...

I love it got up from the couch and cheered then coughed my brains out ...

Update from Calgary they have deployed multiple unit's in their segmented areas just for this (they are addressing this the best way they can cope)

BUT have taken back the vaccines from the Medics because they are not the top priority group now ????? ... Chief Samson ain't a happy camper.

Provincially the official opposition has asked for Immediate resignation of Liepert the Health Minister (btw still no response from he and his family to get there Halloween treats)I would bet all Government officials have been secretly vaccinated.

Come to think of it the billions they are spending with the 4500 km Olympic Torch relay could be the best possible way to spread this across the nation ... go figure EH.

Very pleased docharris community has it together.

[SA_Medic]

We have no inoculation system in place here and treat patients on a case by case basis as they are reported and tested positive. As it is, we are having to import the treatment as there's not enough available. Ah the joys of Africa, only the strong survive here....

[rock_shoes]

Shock and Awe ....... NOT!

First off damn good call rock_shoes your thread on ventolin paid off <insert applause> So did they swab your partner and PM me this would be an excellent case to present to non believers in EMS, or parliament hill too .. sans names of course, my bet the virology labs are at least month behind would be an easy guess.

To the best of my knowledge my partner has not been swabbed. He’s usually a good partner but every so often he’s too much of a stubborn Russian for his own good. He has yet to return to work and frankly I don’t want to see him there until he’s back in good health. The patient in question was transferred out to a higher level facility the same night requiring further respiratory focused care (Kamloops being the closest facility with RT’s available). The transferring crew took full precautions and suffered no ill effects post transfer. Just PM me with any further details you need regarding this case and I’ll fill you in as best I can (sans any information that could be used to identify someone as per usual).

All the clinics are closed in AB now as way too many non priority people followed the Websites Alberta and Canada Health and Media advice and got in huge line's to find they were told go fish.

So ..A house wife with 2 eligible and priority children was interviewed on CTV news basically said and a rough quote:

We followed our Health Ministers advice cause they scared the shit out of us, then told a change of plan and we waited in lines for hours with high risk people in the rain a waste of time and increased exposure ...

GOVERNMENTS PULL YOUR HEAD OUT OF YOUR ASSES.

Another comment was Tim Horton's could do a better job ...

I love it got up from the couch and cheered then coughed my brains out ...

The only thing I’ve seen government do successfully so far is scare the crap out of people. So we have people’s attention. Great. How about using this as an opportunity teach people how to mitigate risk? Nah. That would actually make sense.

Update from Calgary they have deployed multiple unit's in their segmented areas just for this (they are addressing this the best way they can cope)

BUT have taken back the vaccines from the Medics because they are not the top priority group now ????? ... Chief Samson ain't a happy camper.

I’m not sure how I feel about this one. It’s great they are putting a valuable resource to use, but using a resource without taking the steps to protect it is just plain stupid.

Provincially the official opposition has asked for Immediate resignation of Liepert the Health Minister (btw still no response from he and his family to get there Halloween treats)I would bet all Government officials have been secretly vaccinated.

Come to think of it the billions they are spending with the 4500 km Olympic Torch relay could be the best possible way to spread this across the nation ... go figure EH.

Hopefully we can send Falcon to the same special place in hell while we’re at it. The BC legislature just went through first reading of a bill to impose a contract here in BC. Back to work legislation? We never left you ignorant #%#$.

Very pleased docharris community has it together.

At least someone does. Now that we have some leadership in the right direction, let’s get organized already. I know you’re trying Squint. If there’s anything I can do to help put together some kind of proposal/presentation let me know.

Edited November 3, 2009 by rock_shoes